374604834-11-20-2025-08-AS-SJAB-DPLUNW-20251222144436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604834
Report Date: 11/19/2025
Date Signed: 11/20/2025 09:30:07 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/27/2025 and conducted by Evaluator Angelica Boyles

COMPLAINT CONTROL NUMBER: 08-AS-20250827143119

FACILITY NAME:	SUMMER PLACE		FACILITY NUMBER:	374604834
ADMINISTRATOR:	LEKOVIC, DRAGANA		FACILITY TYPE:	740
ADDRESS:	1739 SUMMER PLACE DR		TELEPHONE:	(760) 402-4282
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92021
CAPACITY:	10	CENSUS: 10	DATE:	11/19/2025
		UNANNOUNCED	TIME BEGAN:	08:22 AM
MET WITH:	Caregiver Nita Pabustan		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff did not dispense medication to resident as prescribed.
Staff did not provide adequate personal hygiene care to resident.
Staff did not assist resident with repositioning.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to deliver investigative findings regarding the above mentioned allegation. LPA identified herself, explained the purpose of the visit and nature of the complaint to Caregiver Nita Pabustan. LPA also spoke with Administrator Alex Boskoski and Dragana Lekovic over the phone.

On August 27, 2025 the Department received this complaint which alleged staff did not dispense medication to Resident #1 (R1) as prescribed, staff did not provide adequate personal hygiene care to R1, and staff did not assist R1 with repositioning. [See LIC811 Confidential Name List for a description of select person identifiers used in this report.] The Department’s investigation included a facility tour, record reviews, as well as interviews with residents, staff and outside sources.

(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20250827143119

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SUMMER PLACE	FACILITY NUMBER: 374604834
	VISIT DATE: 11/19/2025

NARRATIVE

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(Continued from LIC9099)

Regarding the allegation that staff did not dispense medication to R1 as prescribed, interviews with residents reported receiving their medications as they should. Interviews with outside sources reported no concerns regarding residents not receiving their medications as prescribed, including stopping or starting medications as ordered by physicians. In reviewing records, there was no evidence to indicate medications not being dispensed as prescribed. LPA did a count audit of R1's medications which indicated the right amount of dosages being administered.

Regarding the allegation that staff did not provide adequate personal hygiene care to R1, interviews with residents reported receiving appropriate hygiene care. Interviews with outside sources reported no concerns regarding the hygiene of residents in care. During LPA unannounced visits LPA observed residents appearing to be clean and well groomed.

Regarding the allegation that staff did not assist R1 with repositioning, R1 reported in an interview not needing assistance in repositioning. A review of R1’s Physician’s Report signed 4/25/25 indicated R1 as nonambulatory and not requiring assistance with turning or repositioning in bed. LPA observed R1 independently transferring in and out of bed.

The Department has investigated the above mentioned. Based upon the information obtained during this investigation, it is determined that the preponderance of evidence was not met to support or corroborate these allegations and therefore deemed unsubstantiated.

An exit interview was conducted with Caregiver Nita Pabustan, to whom a copy of this report and the Licensee’s Rights (LIC9058 01/16) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025

LIC9099 (FAS) - (06/04)

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